title: A dimorphic fungus causing disseminated infection in South Africa.
abstract: BACKGROUND
  The genus emmonsia contains three species that are associated with human disease. Emmonsia crescens and Emmonsia parva are the agents that cause adiaspiromycosis, and one human case of Emmonsia pasteuriana infection has been described. We report a fungal pathogen within the genus emmonsia that is most closely related to E. pasteuriana in human immunodeficiency virus (HIV)-infected adults in South Africa.
  
  
  METHODS
  Between July 2008 and July 2011, we conducted enhanced surveillance to identify the cause of systemic, dimorphic fungal infections in patients presenting to Groote Schuur Hospital and other hospitals affiliated with the University of Cape Town, Cape Town, South Africa. DNA sequencing was used to identify pathogenic fungi.
  
  
  RESULTS
  A total of 24 cases of dimorphic fungal infection were diagnosed, 13 of which were caused by an emmonsia species. All 13 patients were HIV-infected, with a median CD4+ T-cell count of 16 cells per cubic millimeter (interquartile range, 10 to 44), and all had evidence of disseminated fungal disease. Three patients died soon after presentation, but the others had a good response to a variety of antifungal agents and antiretroviral therapy. Phylogenetic analysis of five genes (LSU, ITS1-2, and the genes encoding actin, β-tubulin, and intein PRP8) revealed that this fungus belongs in the genus emmonsia and is most closely related to E. pasteuriana.
  
  
  CONCLUSIONS
  The findings suggest that these isolates of an emmonsia species represent a new species of dimorphic fungus that is pathogenic to humans. The species appears to be an important cause of infections in Cape Town.
authors.affiliation: Division of Infectious Diseases and HIV Medicine, Department of Medicine, Groote Schuur Hospital, Cape Town, South Africa. chriskenyon0@gmail.com
authors.forename: Chris
authors.initials: C
authors.lastname: Kenyon
authors.forename: Kim
authors.initials: K
authors.lastname: Bonorchis
authors.forename: Craig
authors.initials: C
authors.lastname: Corcoran
authors.forename: Graeme
authors.initials: G
authors.lastname: Meintjes
authors.forename: Michael
authors.initials: M
authors.lastname: Locketz
authors.forename: Rannakoe
authors.initials: R
authors.lastname: Lehloenya
authors.forename: Hester F
authors.initials: HF
authors.lastname: Vismer
authors.forename: Preneshni
authors.initials: P
authors.lastname: Naicker
authors.forename: Hans
authors.initials: H
authors.lastname: Prozesky
authors.forename: Marelize
authors.initials: M
authors.lastname: van Wyk
authors.forename: Colleen
authors.initials: C
authors.lastname: Bamford
authors.forename: Moira
authors.initials: M
authors.lastname: du Plooy
authors.forename: Gail
authors.initials: G
authors.lastname: Imrie
authors.forename: Sipho
authors.initials: S
authors.lastname: Dlamini
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Borman
authors.forename: Robert
authors.initials: R
authors.lastname: Colebunders
authors.forename: Cedric P
authors.initials: CP
authors.lastname: Yansouni
authors.forename: Marc
authors.initials: M
authors.lastname: Mendelson
authors.forename: Nelesh P
authors.initials: NP
authors.lastname: Govender
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000382:microbiology*; D000328:Adult; D002912:Chrysosporium / Q000145:classification / Q000235:genetics / Q000302:isolation & purification / Q000472:pathogenicity; D005260:Female; D015658:HIV Infections / Q000150:complications; D006801:Humans; D008297:Male; D009181:Mycoses / Q000382:microbiology*; D010802:Phylogeny; D013019:South Africa